Anaplastic Thyroid Carcinoma Workup
- Author: Anastasios K Konstantakos, MD; Chief Editor: Jules E Harris, MD more...
Laboratory Studies
- Anaplastic thyroid carcinoma (ATC) cannot be definitively diagnosed with laboratory examinations of the blood or urine.
- Obtain serum calcium levels to rule out medullary thyroid carcinoma or parathyroid neoplasms.
Imaging Studies
- Chest radiography may be used to determine the presence of lung metastases.
- Preoperative cervical ultrasonography can detect lymph node metastases.
- Cervical CT scanning can be used to define the local spread of disease. Detection of distant metastases to the mediastinum, liver, lung, bone, and brain is also possible via CT scanning or MRI.
- Bone scanning can be used to determine the presence of bone metastases.
- Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) can visualize primary tumors, lymph node metastases, lung metastases, and other distant metastases.[4]
Procedures
- Fine-needle aspiration often yields enough cytologic information to allow diagnosis; however, if the fine-needle aspiration does not provide definitive results, the patient may require an open surgical biopsy.
Histologic Findings
Grossly, anaplastic carcinoma of the thyroid (ATC) is a large, fleshy, off-white tumor. Infiltration of adjacent structures can be observed grossly and microscopically. Histologically, the tumor may contain regions of spontaneous necrosis and hemorrhage. Typically, angioinvasion is detectable.
The main histologic variants include spindle cell, giant cell (osteoclastlike), squamoid, and paucicellular. The giant cell subtype typically exhibits local calcification with significant osteoid formation. The paucicellular subtype demonstrates rapid growth, intense fibrosis, focal infarction, diffuse calcification, and encroachment of adjacent vascular tissue by atypical spindle cells.
Thyroid lymphoma is the only curable condition that may be confused with ATC. Rule out lymphoma in the presence of a poorly differentiated large cell thyroid tumor. This investigation involves lymphoid tissue markers (eg, cytoplasmic immunoglobulin, immunoglobulin receptors, gene rearrangement studies).
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